Combined Access for the Treatment of Medial Orbital Wall Fracture: Subciliary and Upper Eyelid Sulcus Incisions.

The present study presents a new surgical approach to treat medial orbital wall fractures, that is, the combined transcutaneous access through subciliary and upper eyelid sulcus incisions. The study performed the retrospective analysis of medical records belonging to 14 consecutive patients with medial orbital wall fracture, who were treated in the Plastic Surgery Division at Federal University of São Paulo, from 2005 to 2013, through the combination of subciliary and upper eyelid sulcus incisions to access the fracture foci. The mean age of the patients was 35.4 years, ranging from 8 to 66 years. Seven out of the 14 patients were women. Ten patients had fractures in the medial and inferior walls, whereas 4 patients had isolated medial wall fracture. Diplopia was found in all cases. Six patients had some type of extraocular muscle limitation. A computed tomography of the face was performed in the postoperative period to assess the orbital contour and the correct position of the grafts, whenever applicable. The patients were assessed for diplopia, enophthalmos, and scar quality. Four patients (28.6%) kept on showing diplopia at supraversion, whereas 2 patients (14.2%) evolved to enophthalmos. There was no need of reoperating the patients to reposition the grafts or the absorbable plaque. No patient evolved to ectropion or apparent scarring. The combined transcutaneous access through subciliary and upper eyelid sulcus incisions provides ample operative field, rapid exposure of the fracture foci, and adequate wall reconstruction. It can also present inconspicuous scar.